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Ulcerative Colitis Overview & Symptoms

Ulcerative Colitis is a chronic Inflammatory Bowel Disease (IBD) with ulceration in the colon. Approximately 1 million Americans have IBD – half of whom have Ulcerative Colitis (UC). Both men and women have an equal chance of being affected and the amount of young people with Ulcerative Colitis seems to be increasing at an alarming rate in the western world.

Symptoms of Ulcerative Colitis may include:

  • Abdominal pain/cramping
  • Diarrhea (often bloody and/or with mucous)
  • Urgency and feeling of 'not all done'
  • Persistent fatigue
  • Intestinal 'gurgling'
  • Fever
  • Bloating and Gas
  • Loss of Appetite
  • Nausea and/or Vomiting
  • Weight loss
  • Joint pain
  • Skin lesions
  • Anemia

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Ulcerative colitis has many of the symptoms that other bowel conditions exhibit. Bacterial, viral, and infections from parasites can be the same as those of ulcerative colitis. The symptoms of ulcerative colitis have a lot of variety including severity, time of year and onset (rapid or gradual) and vary between one patient and the next. Common symptoms of ulcerative colitis include rectal bleeding and diarrhea. Variability of symptoms seem to differ depending on how much of the colon and rectum are involved and the severity of inflammation. Abdominal pain, cramping and a severe urgency to have a bowel movement or feeling like you have to have another bowel movement after you have just gone. Bloating and gas are common. Weight loss, fatigue and dehydration is also seen in ulcerative colitis patients. Skin lesions, fever, loss of appetite, nausea and joint pain may also occur.

Other conditions sometimes seen with ulcerative colitis include malnutrition and anemia, arthritis, osteoporosis, eye inflammation and liver disease. Quality of life can be deeply affected for those who suffer with ulcerative colitis. One study found over 40% of those with UC also experienced anxiety and depression.

The disease may involve the entire colon (pancolitis), the rectum only (ulcerative proctitis) or, more commonly, somewhere between the two. Depending on the area affected by the ulcerative colitis is it classified into these 4 categories:

Proctitis. This category of ulcerative colitis involves the rectum, the last part of the colon near the anus. Rectal bleeding may be the only sign of this disease though some may have rectal pain, a feeling of urgency or constipation in spite of having the urge to do go (tenesmus).

Left-sided colitis. As described in its name, this form of ulcerative colitis occurs from the rectum to the splenic flexure – the area just below the ribs on your left side. This ulcerative colitis extends from the rectum up the left side through the sigmoid part of the colon and the descending colon. There is usually bloody diarrhea, abdominal cramping and pain, and sometimes weight loss.

Pancolitis. This type of ulcerative colitis involves the entire colon. Symptoms include bloody diarrhea (severe), abdominal cramping with pain, weight loss, fatigue and night sweats.

Fulminant colitis. This condition, though rare, can be life-threatening. It affects the entire colon, causes severe pain, profuse diarrhea and can lead to dehydration and shock. Fulminant colitis may have serious complications including colon rupture and toxic megacolon.

Tests and Diagnosis for Ulcerative Colitis

Usually a stool sample is the first order to rule out infection or parasites (the symptoms presenting may be the same). Blood tests may show anemia and elevated white blood cells and sedimentation rate which may show anemia and indicate inflammation. An Endoscopy and/or Colonoscopy is used to visualize the area and differentiate between Crohn’s Disease and/or the extent of Ulcerative Colitis. A Biopsy of the lining is taken to visualize the severity of the Colitis and to rule out cancer of the colon. Sometimes a Barium Enema (a type of x-ray) is used to determine the extent and severity of Ulcerative Colitis though generally it is not as effective as a colonoscopy.

Different Types of Colitis

There are many types of colitis. Some of these are:

Ulcerative Colitis. This is the most common type of colitis and the primary type this website deals with. It affects the large intestine and is an Inflammatory Bowel Disease like Crohn’s Disease. Its name stems from the ulcers that form from the disease.

Colitis Diverticulitis. Colitis diverticulitis (or Diverticulitis colitis) is when there is chronic inflamation of the colon (colitis) coupled with diverticulitis.

Crohn’s Colitis. In Crohn's disease, if only the large intestine is affected with colitis it is referred to as Crohn's colitis or granulomatus colitis. When only the small intestine is involved it is called colitis enteritis. Both Crohn's and Ulcerative colitis are Inflammatory Bowel Diseases (IBD) and can have similar symptoms.

Collagenous Colitis. Collagenous colitis is a subtype of microscopic colitis wherein on biopsy, the protein collagen is present. This more often presents in women primarily over the age of 50, and some suspect the high dosage of estrogens and NSAID's to be contributory.

Ischemic Colitis. This disorder develops when there is a severe reduction or loss of blood to the colon. Symptoms are typically pain on the left side of the abdomen with bloody diarrhea.

Infectious Colitis. This results from infection by a toxic strain of colostridium difficile, the shiga toxin or other e. coli.

CMV Colitis. Colitis caused by the cytomegalovirus.

Radiation Colitis. Colitis that results from higher levels of radiation directly or indirectly to the area of the bowel, often seen with cancer therapy.

Necrotizing Enterocolitis. Seen when tissue in the colon dies. Primarily seen in sick and/or premature infants.

Lymphocytic Colitis. A type of microscopic colitis (named so because of the lymphocytes) that usually resolve on it's own within a few weeks (but not always).

Pseudomembranous Colitis. A type of colitis that is usually caused by an overpopulation of the clostridium difficile bacteria.

Microscopic Colitis. Microscopic colitis most often occurs in women (though not always) and is often seen with autoimmune disease. The primary symptom is chronic, watery diarrhea. Often it is misdiagnosed because the initial colonoscopy (especially if it is only a rectal colonoscopy) is normal. A full colonoscopy with multiple biopsies is often required for a correct diagnosis. Microscopic colitis has been known to respond very well to natural and homeopathic remedies.

Cryptosporidium Enteritis. Affects the small and large intestine and is caused by the cryptosporidium parasite.

Diversion Colitis. An inflammatory bowel condition that may affect those who have undergone an ileostomy or colostomy in the area that has been by-passed.

Chemical Colitis. A rare form of colitis that occurs accidentally, from agents used with endoscopes or from caustic chemicals used in an enema.

Indeterminate Colitis. A term used generally as a preliminary diagnosis or when a definitive diagnosis can not be made for typing of the colitis.

Atypical Colitis. A term used when colitis does not fit into a designated category or type.